SHM Converge Scientific Abstract ePoster Gallery-A Case of Severe Plasmodium Falciparum Malaria With Pulmonary Manifestations

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This case describes a 32-year-old man in the United States who developed severe <em>Plasmodium falciparum</em> malaria after traveling to Ghana and not taking malaria prophylaxis consistently. He presented with 4 days of fever, chills, headache, vomiting, diarrhea, body aches, weakness, and poor appetite. On arrival, he was febrile, tachycardic, and hypotensive but not initially hypoxic. Blood smear showed parasites with 18% parasitemia, along with thrombocytopenia, anemia, elevated creatinine, and elevated LDH, confirming severe malaria.

He was started on quinine and doxycycline. Over several days, his parasitemia improved to 1.5%, but he then developed acute respiratory distress and hypoxia despite the falling parasite burden. Repeat chest imaging showed new bilateral lower-lobe infiltrates, and CT demonstrated pulmonary edema with bilateral pleural effusions. Echocardiogram revealed elevated pulmonary pressures but normal ejection fraction and no valvular disease, suggesting a noncardiogenic pulmonary complication of malaria.

The report emphasizes that respiratory manifestations occur in about 25% of adults with severe <em>P. falciparum</em> malaria and may appear before or after treatment, even as parasitemia improves. The mechanism is increased alveolar permeability leading to fluid shift into the lungs.

The patient ultimately recovered fully with treatment. The authors note that intravenous artesunate is preferred over quinine for severe malaria because it lowers mortality risk, but access may be delayed in community hospitals. This case highlights the need to monitor for pulmonary complications in severe malaria, even after parasitemia begins to resolve.

Asset Subtitle

Ava Sadeghi

Meta Tag

Author List Aqsa Mumtaz, Ava Sadeghi, Mahmoud El Hajj, Shawn Brito

Category Clinical Vignettes

Concept Plasmodium falciparum

Concept Malaria

Concept Intravenous artesunate

Concept Acute Respiratory Distress Syndrome

Concept Parasitemia

Distinguished Non-Finalist

Presenter Organization Montefiore St. Luke's Cornwall Hosptial

Presenting Author Ava Sadeghi

Track Adult

Keywords

Plasmodium falciparum

severe malaria

Ghana travel

malaria prophylaxis

parasitemia

thrombocytopenia

acute respiratory distress

pulmonary edema

quinine doxycycline

intravenous artesunate

Plasmodium falciparum

Malaria

Intravenous artesunate

Acute Respiratory Distress Syndrome

Parasitemia